Friday, March 23, 2007

ALEXITHYMIA GLOSSARY

Terms and colloquialisms commonly used in discussions about Alexithymia:

Alexithymia: A-lexi-thymia = no-words-(for)emotions.Alexithymia is a disorder of emotion cognition constituted by an inability to recognise, interpret, and verbalize physical signs of emotional-arousal in oneself or others. This inability is underpinned by a deficit in spontaneous imaginal activity such as dreaming, reverie, emotion imaging, and fantasy (see entries on imagination below).

Alexithymia construct (the): since it’s early conceptualisation by Sifneos the alexithymia construct has been refined theoretically, and is presently defined as: (i) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal; (ii) difficulty describing feelings to other people; (iii) constricted imaginal processes, as evidenced by a paucity of fantasies; and (iv) a stimulus-bound, externally oriented cognitive style.

Alex: short for the concept of 'alexithymia', or for a person who has alexithymia (i.e. "an alex").

Alexithymic: referring to someone with alexithymia, or to a trait associated with alexithymia such as "he displays an alexithymic communication style".

Anhedonia: The alexithymic tendency to negativity has its roots in the need to destroy positive experiences which threaten to disturb the otherwise controlled cognitive style, and is linked to the condition of anhedonia: the inability to experience pleasure from normally pleasurable life events such as eating, exercise, and social/sexual interactions. The presence of anhedonia in an alexithymic individual indicates that the whole problem may be of traumatic origin. Those with trauma-based alexithymia have strong guilt feelings about experiencing any pleasure or gratification, and so employ blocking mechanisms against consciously experiencing playful and pleasurable emotions. The general attitude, says Henry Krystal, becomes one "of suppressing and minimizing all achievements and maximizing the negatives.""No" seems to be the favourite default response to a variety of propositions posed to the alexithymic individual. Even when a positive question like "The weather is fine, why don't we go for a walk" is posed, it is not unusual for an alexithymic individual to respond with a negative: "No… well I’m not sure… do you think its going to rain?" even while trying to affirm their willingness to participate. This nay-saying includes the tendency to point out what is 'wrong' before considering what is right, and a preference for veto-power over assent in social situations, all of which stands as a general negation of potential self-experience. Negation, moreover, said Freud, is repression: "A negative judgment is the intellectual substitution for repression."

Emotional intelligence: developing initially along separate lines, the constructs of alexithymia and emotional intelligence came to the attention of researchers who realized these were intimately related, with alexithymia representing the lower possible range of emotional intelligence. This realization has spawned a rich cross-fertilization of the two traditions whereby aspects of each may be considered as complimentary ends of a single emotional intelligence spectrum.

Feeler: a person possessing the normal range of feeling abilities; i.e. a non-alexithymic.

Hypochondria: A typical alexithymic shows all the usual bodily signs of emotional arousal, but there is an inability to identify these signs as emotions and the individual is left to interpret the bodily changes as physical disease or illness: the anxious tummy becomes an ulcer or food poisoning; the nervous bowel, cancer or worms; and the amorous heart, arrhythmia. Hypochondria is a somatoform disorder in which one has the unfounded belief that they are suffering from a serious illness, characterised by irrational fears of being diseased, or obsessions over minor bodily symptoms or imperfections. Commonly included is disbelief or doubt about the accuracy of doctors diagnosis, combined with obsessive self-examination and self-diagnosis, and a preoccupation with one's body. The hypochondria associated with alexithymia is not related to the 'factitious disorders' such as Munchausen syndrome in which an individual intentionally fakes, exaggerates, or induces mental or physical illnesses in order to assume the role of a "patient".

Involuntary emotional expression: Some alexithymic individuals manifest sudden and unpredictable episodes of crying, laughing, rage, and other emotional displays which are out of proportion to the aggravating stimulus, or are discordant with the specific event. When questioned regarding the reasons for the outburst they are often unable to link the behaviour with any memories or provocations, and may manufacture an excuse. A notable cause for such outbursts includes the operation of displacement whereby strong emotions elicited by a previous stimulus are discharged on a new unrelated person or object. When faced with aggravations such as a financial difficulty, child frustrations, or social stresses the person is unable to recognise the emotional states initiated by the problem, leaving them prone to sudden outbursts which are misdirected and displaced, sometimes under a slight provocation, onto the nearest bystander with verbal or physical demonstrations.

Primary alexithymia: refers to an enduring condition which seems to alter little over time or with changing circumstances. This form of alexithymia is not situation dependent (see ‘secondary-alexithymia’ below), and remains persistent due to neurological defects or internalised object-relations systema which radically alter normal neuronal activity.

Secondary alexithymia: a state/situation-dependent form of alexithymia which disappears after the evoking stressful situation has changed. Stressful situations might include various severe physical illnesses, or socially maintained psychological trauma or stresses. Secondary-alexithymia is considered more likely than primary-alexithymia to be responsive to therapy, although it is arguably still possible in the latter case.

Normative male alexithymia: an erroneous application of the clinical alexithymia concept. This term refers to a proposed male stoicism, emotional-repressiveness, and lack of verbal skill in describing feelings. These behaviours do not constitute alexithymia and the majority of studies have shown that males and females have an equal chance of developing the condition, therefore the misuse of the alexithymia term here is unfortunate. Alexithymia refers primarily to an individual’s inability to recognise feelings, moreso than a reluctance or handicap in verbalizing feelings. Males are known to score on average as well as females in recognising emotions, but are generally reluctant to verbalise the words they do have for feelings due to cultural expectations and lack of practice in verbal expression. Alexithymics on the contrary typically do not recognise their feelings. The use of this term to connote that all males are “emotional dummies” may reflect stereotyping of contemporary gender politics more than it does the rigor of objective scientific method.

Imagephobia/pseudophobia: A fear of imagination and fantasy as may be the case for many alexithymics who cannot tolerate the emotional component of imagination. An ‘intolerance’ of imagination is present and the mechanism of primal-repression activated to block formation of emotionally toned images and fantasies.

Spontaneous imagination: involves unpredictable imaginative processes such as dreaming, reverie, emotion imaging, and fantasy and imagination accompanying instinctual wishes and drives. Spontaneous imagining is unpredictable, involuntary, and surprising. This form of imagining is in deficit in alexithymia.

Controlled imagination: can be defined as an intellectually controlled conception of images or of image sequences (whether it be in composing music, visualizing strategies in a sport, picturing a scientific experiment and its possible outcomes, or even in artistic fields such as painting or poetry). The alexithymic mind specializes in this form of imagining, but is underproductive in spontaneous imagination.

Repression proper: an 'unconscious' process of censoring, controlling, or excluding from consciousness any pre-constellated impulses, memories, desires, fantasies, thoughts, or feelings which produce anxiety or guilt. This form of repression is sometimes described as "after-repression" because it operates on mental contents "after" they have formed in one's mind, whereas primal-repression can be characterized as "before-repression" i.e. it represses mental contents from even initially forming.

Primal repression: an 'unconscious' defense in which person's experiences (particularly traumatic ones) are 'blocked' from being cognised whatsoever as thoughts, feelings, or fantasies. Experiences are instead recorded purely as sensory impressions, physiological reactions, and isolated images and emotions. Primal Repressionis thought to be involved in alexithymia.

Stimulus-bound, externally-oriented cognitive style: a sub-factor of the alexithymia construct involving impoverished fantasy life, utilitarian thinking and a focus on external concrete data of the sensate environment. This sub-factor is an extreme example of Carl Jung’s ‘extraverted sensing type’ (1921) and also of Marty M'Uzan’s later concept pensee operatoire (1963).

Vicarious emotion interpreting: If asked: "Tell me what you want, from the heart?" the answer from an alexithymic individual may seem entirely random. These answers are rarely convincing, often taking the form of ‘potted responses’ (see below). Most alexithymics can only answer such questions based on intellectually constructed principles, and if they can't do that, the answer is random because the idea of "just knowing" or of something "feeling right" is quite alien to them. People who cannot rely on their own feelings contract out the task to others, hence alexithymics characteristically defer emotion interpretation to other people, actively evoking feelings in surrogates -friends, partners, parents, therapists. Sometimes they may then borrow the others’ emotion-interpretations to re-state as their own.

Potted responses: refer to any of a repertoire of verbal responses an alexithymic individual might use, such as “Golly!” “Gee!” "My goodness!" “Gosh!” “Oh, that’s no good is it” “Wow, that’s great isn’t it!” which are stated to another as versatile responses amenable to a large variety of feeling-toned events, i.e. with the right intonation these responses can mean anything to anyone. An alexithymic individual may use a typically small repertoire of suchresponses (whereas a non-alexithymic may employ an extensive vocabulary consisting in the hundreds of feeling-words and phrases) which inject a feeling tone into discussions, but words which, unbeknown to the listener feel artificial or insincere to the speaker who is ‘acting’ the part. Whilst alexithymic individuals are capable of discussing subjects comfortably on an intellectual level, there is no such comfortability when faced with the prospect of feelings-based communication. Here, a repertoire of potted responses helps avoid embarrassment in sticky social situations which require a feeling response. Body gestures, laughs and sighs may also be employed in the same manner.

Alexithymic communication: Individuals who score in the high range on alexithymia measures display “type-C communication” (Lang) by means of which communication-mode the essential links between patient and therapist are broken and ruptured; in which verbalization and apparent efforts at communication are actually designed to destroy meaning, generate falsifications, and to create impenetrable barriers to underlying catastrophic truths. This communicative mode is designed for falsification, the destruction of links between subject and object, and for the erection of barriers. Here the trend is to non-communication, for the destruction of meaning, and the absence of derivative expression.

Alexithymic parenting: Alexithymic individuals pose five problems in their parenting style for their developing children: 1. a profound inability to recognize and help regulate the infant/child’s emotional life. 2. a tendency to misperceive a child’s gestures (crying, frustration or silence) as ‘bad’ or ‘naughty’.3.a tendency to discharge anger or otherwise emotionally vent at children due to the alexithymic parent’s own unmodulated affective chaos. 4. actively compelling the child to regulate his/her own emotional states -e.g. to child: "tell me what you need"- which places premature pressure on children's underdeveloped emotion-cognition abilities, OR by inciting (in various ways) vicarious interpretations from the child to help the alexithymic parent make sense of their own emotional confusion. And 5. a tendency toward concrete, mechanical, and rigid parenting behaviour similar to that of the obsessive-compulsive parenting style. These five factors alone are considerable enough to promote serious and enduring psychological problems for children. Some children of alexithymic parents may achieve good-enough psychological health due to influences from non-alexithymic parents (if one is available), and by the child's peers. Without these non-alexithymic support persons the psychological future of the exclusively alexithymia-parented child may be a problematic one. Support for the 'alexithymic family' is the key here.